2025 HCPCS code HF
This modifier indicates that the service or procedure was provided to a participant in a substance use disorder (SUD) program.
Medical necessity for services provided to individuals in SUD programs must be established based on the patient's diagnosis, treatment plan, and the specific service provided.The HF modifier helps payers identify services related to substance abuse treatment, ensuring that claims align with program requirements and coverage policies.
The clinician is responsible for correctly applying the HF modifier when billing for services provided to participants in substance abuse programs. They must understand and adhere to the specific guidelines set forth by the program, sponsoring agency, and the payer.
In simple words: This code is used when a healthcare provider performs a service for someone in a drug or alcohol treatment program.
Modifier HF is appended to a Healthcare Common Procedure Coding System (HCPCS) code to specify that the service being billed was delivered to a patient actively participating in a substance abuse program.The specific application of this modifier can vary based on the specific SUD program, the agency sponsoring the program, and the payer's guidelines.It's crucial to consult the payer's guidelines to determine which codes require or allow the use of the HF modifier for accurate billing and reimbursement.
Example 1: A patient receiving medication-assisted treatment (MAT) for opioid dependence at a federally qualified health center. The HF modifier would be appended to the HCPCS code for the administered medication., A patient undergoing individual therapy sessions as part of their treatment plan at an outpatient substance abuse clinic. The HF modifier would be appended to the HCPCS code for the therapy session., A patient receiving urine drug screening at a laboratory as part of their ongoing monitoring in a substance abuse program.The HF modifier would be appended to the HCPCS code for the urine drug screen.
Documentation supporting the medical necessity of the service and the patient's active participation in a substance abuse program is essential.This may include treatment plans, progress notes, and program enrollment verification.
- Specialties:Addiction medicine, behavioral health, and other specialties involved in substance use disorder treatment.
- Place of Service:Federally Qualified Health Center, Community Mental Health Center, Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, Residential Substance Abuse Treatment Facility, Outpatient Hospitals, and other places of service where SUD treatment is rendered.